Obesity and diabetes can affect breastfeeding

Obesity and diabetes can affect breastfeeding in several ways.


  • Reduced milk production: Obese women may have lower levels of prolactin, the hormone responsible for milk production. This can lead to a reduced supply of breast milk.
  • Increased risk of mastitis: Mastitis is an inflammation of the breast tissue that can occur during breastfeeding. Obese women are at increased risk of developing mastitis.
  • Delayed lactogenesis II: Lactogenesis II is the “let-down” reflex that triggers the release of breast milk. Obese women may experience delayed lactogenesis II, which can make it more difficult for them to breastfeed.
  • Shorter breastfeeding duration: Obese women are more likely to stop breastfeeding early.


  • Increased risk of hypoglycemia (low blood sugar) in the baby: Breast milk from mothers with diabetes may contain higher levels of glucose, which can lead to hypoglycemia in the baby.
  • Increased risk of macrosomia (large baby): Babies born to mothers with diabetes are at increased risk of macrosomia, which can make it more difficult for them to latch on and breastfeed.
  • Delayed lactogenesis II: Similar to obese women, women with diabetes may experience delayed lactogenesis II.
  • Shorter breastfeeding duration: Women with diabetes are more likely to stop breastfeeding early.

Despite these challenges, breastfeeding is still possible for women with obesity and diabetes. With proper support and education, these women can successfully breastfeed their babies.

Here are some tips for breastfeeding mothers with obesity or diabetes:

  • Work with a lactation consultant: A lactation consultant can provide support and education to help you breastfeed successfully.
  • Monitor your blood sugar levels: If you have diabetes, it is important to monitor your blood sugar levels regularly.
  • Eat a healthy diet: Eating a healthy diet can help you control your blood sugar levels and produce nutritious breast milk.
  • Get regular exercise: Regular exercise can help you control your weight and blood sugar levels.
  • Join a support group: Joining a support group can connect you with other breastfeeding mothers who are facing similar challenges.

Breastfeeding is a healthy and natural way to feed your baby. With proper care and support, women with obesity and diabetes can successfully breastfeed their babies.

Advantages of Breastfeeding

1. Optimal Nutrition:

  • Breast milk is tailor-made for the infant, providing all essential nutrients.
  • Rich in antibodies, boosts the baby’s immune system.Are you a nursing mom? Pay attention to these 3 effective breastfeeding positions | HealthShots

2. Bonding and Emotional Well-being:

  • Skin-to-skin contact during breastfeeding fosters emotional connection.
  • Releases oxytocin, promoting maternal-infant bonding.

3. Lowered Risk of Infections:

  • Colostrum (first milk) contains antibodies and immunoglobulins.
  • Reduces the risk of respiratory, ear, and gastrointestinal infections.

4. Cognitive Development:

  • Omega-3 fatty acids in breast milk support brain development.
  • Linked to higher IQ and improved cognitive function.

5. Reduced Allergies and Asthma:

  • Lower incidence of allergies, eczema, and asthma in breastfed infants.
  • Protective factors in breast milk.

Your Baby and Breastfeeding

6. Digestive Health:

  • Easier to digest than formula, reducing the risk of constipation.
  • Decreases the likelihood of colic and gastroesophageal reflux.

7. Weight Management:

  • Promotes healthy weight gain in infants.
  • Decreases the risk of childhood obesity.

8. Cost-Efficient:

  • Breast milk is free, eliminating the need for formula.
  • Fewer doctor visits due to better health outcomes.

9. Environmental Sustainability:

  • Reduced carbon footprint compared to formula production.
  • Decreases plastic waste from formula containers.

10. Maternal Health Benefits: – Helps with postpartum weight loss. – Reduces the risk of postpartum depression. – Lowers the risk of breast and ovarian cancer.

Does breastfeeding hurt? | baby gooroo


  • Breastfeeding is a crucial foundation for a healthy start in life.
  • Provides numerous advantages for both infants and mothers.
  • Promotes health, bonding, and environmental sustainability.
  • Encouraging breastfeeding contributes to a brighter and healthier future.

Dengue fever

DENGUE AND SMOG | Transport DepartmentDengue fever is a mosquito-borne viral infection that can cause flu-like symptoms and, in severe cases, potentially life-threatening complications. It is caused by the dengue virus, which is transmitted to humans primarily through the bite of infected female Aedes mosquitoes, particularly Aedes aegypti and Aedes albopictus. Dengue fever is common in tropical and subtropical regions of the world, including parts of Southeast Asia, the Pacific Islands, the Caribbean, and Central and South America.

Here are some key points about dengue fever:


The symptoms of dengue fever typically appear 4-10 days after being bitten by an infected mosquito and can include high fever, severe headache, pain behind the eyes, joint and muscle pain, rash, and mild bleeding. In some cases, dengue fever can progress to a more severe form known as dengue hemorrhagic fever or dengue shock syndrome, which can be life-threatening.

Dengue fever presents with a wide range of signs and symptoms that can vary in severity. The disease typically has an incubation period of 4-10 days after being bitten by an infected mosquito. The symptoms of dengue fever can be categorized into three phases: the febrile phase, the critical phase, and the recovery phase. Not all individuals with dengue infection will progress through all three phases, and the severity of symptoms can vary from mild to severe. Here are the common signs and symptoms associated with each phase:

  1. Febrile Phase (Acute Phase):

High Fever: Sudden onset of high fever, often reaching up to 104°F (40°C).

Severe Headache: Intense frontal headache, which is a common feature of dengue fever.

Pain Behind the Eyes: Pain or discomfort, especially when moving the eyes.

Joint and Muscle Pain: Severe joint and muscle pain, often referred to as “breakbone fever.”

Rash: A rash may develop, typically starting a few days after the onset of fever. It can be maculopapular (red and raised) and sometimes itchy.

Fatigue: Extreme fatigue and weakness.

Nausea and Vomiting: Some individuals may experience nausea and vomiting.

Mild Bleeding: Minor bleeding manifestations such as nosebleeds, gum bleeding, or easy bruising can occur.

  1. Critical Phase (Warning Signs):

Around the 3-7 day mark, some patients with dengue fever may progress to a critical phase. Warning signs indicate increased severity and the potential for complications. These signs include:

Persistent Abdominal Pain: Severe abdominal pain may develop, which can be a sign of impending complications like dengue hemorrhagic fever.

Vomiting with Blood: Vomiting blood (hematemesis) or passing blood in the stool (melena) can occur.

Bleeding: Severe bleeding, such as from the nose or gums, petechiae (small red or purple spots on the skin), or hematuria (blood in the urine).

Rapid Breathing: Increased respiratory rate and difficulty breathing.

Cold or Clammy Skin: Skin may become cold, pale, or clammy.

Restlessness: Agitation or restlessness may be observed.

  1. Recovery Phase:

After the critical phase, most patients gradually recover over the next few days to weeks.

The fever subsides, and other symptoms begin to improve.

Convalescence: Patients may experience fatigue and weakness during the recovery phase, which can persist for an extended period.

It’s important to note that not all individuals with dengue fever progress to the critical phase or develop severe symptoms. The majority of cases are mild, and with proper medical care and supportive treatment, the prognosis is usually favorable. However, severe dengue (such as dengue hemorrhagic fever or dengue shock syndrome) can be life-threatening and requires immediate medical attention.

If you or someone you know exhibits the warning signs of dengue fever, it’s crucial to seek medical care promptly to prevent complications and ensure appropriate treatment and monitoring.

Diagnosis: Dengue fever is usually diagnosed through blood tests that detect the presence of the dengue virus or antibodies produced in response to the virus.

Laboratory findings play a significant role in the diagnosis and management of dengue fever. The results of various laboratory tests can help confirm the presence of the dengue virus, assess the severity of the infection, and guide treatment decisions. Here are some of the key laboratory findings associated with dengue fever:

Dengue Serology (Antibody Tests):

IgM Antibodies: In the early stages of the illness (usually within the first week), dengue-specific IgM antibodies can be detected in the patient’s blood. The presence of IgM antibodies suggests a recent dengue infection.

IgG Antibodies: Dengue-specific IgG antibodies may appear later and persist for a more extended period. Elevated IgG levels may indicate a past dengue infection.

Polymerase Chain Reaction (PCR) Test:

Dengue PCR: This test detects the genetic material (RNA) of the dengue virus in a patient’s blood. It is most useful in the early days of infection, even before the appearance of IgM antibodies. PCR can help confirm an acute dengue infection and identify the specific serotype of the virus.

Complete Blood Count (CBC):

Platelet Count: One of the hallmark laboratory findings in dengue fever is a decrease in platelet count (thrombocytopenia). Platelets are essential for blood clotting, and low platelet levels can lead to bleeding tendencies.

Hematocrit (Hct) Levels: An elevated hematocrit (a measure of the proportion of red blood cells in the blood) can indicate hemoconcentration, which is common in dengue fever due to plasma leakage.

Liver Function Tests:

AST (Aspartate Aminotransferase) and ALT (Alanine Aminotransferase): Elevated levels of these liver enzymes are often seen in dengue patients, indicating liver involvement.

Coagulation Profile:

PT (Prothrombin Time) and APTT (Activated Partial Thromboplastin Time): These tests assess the blood’s clotting ability. Prolonged PT and APTT may be seen in severe cases of dengue with bleeding tendencies.

Electrolyte Levels:

Sodium (Na) and Potassium (K): Abnormal electrolyte levels can occur due to fluid imbalances in dengue patients, especially those with severe symptoms.

Creatinine and Urea Levels:

Kidney Function Tests: Elevated creatinine and urea levels may indicate kidney involvement in severe dengue cases.

Other Tests:

NS1 Antigen Test: This test can detect the presence of the dengue virus NS1 antigen in a patient’s blood and is useful for early diagnosis.

Dengue Serotyping: In areas with multiple dengue virus serotypes, it’s important to identify the specific serotype causing the infection as some serotypes are associated with more severe disease.

Laboratory findings in dengue fever can vary depending on the stage of the infection and the severity of the disease. These tests help healthcare providers confirm the diagnosis, assess the patient’s condition, and make decisions regarding treatment and monitoring. It’s important to note that dengue fever is a dynamic disease, and laboratory findings may change over the course of the illness, so repeated testing and close monitoring are often necessary, especially in severe cases.


The best way to prevent dengue fever is to avoid mosquito bites. This can be achieved by using insect repellent, wearing long-sleeved clothing, and staying in air-conditioned or screened-in accommodations. Additionally, efforts to reduce mosquito breeding sites, such as eliminating standing water around homes, are essential for dengue prevention.


As of my last knowledge update in September 2021, there was an approved dengue vaccine called Dengvaxia. However, its use and availability varied by country, and it was primarily recommended for individuals who had previously been infected with dengue. Vaccine availability and recommendations may have evolved since then, so it’s essential to check with local health authorities for the most up-to-date information on dengue vaccines.

It’s important to note that dengue fever can be a serious illness, and early detection and medical care are crucial for managing the disease effectively, especially in severe cases. If you suspect you have dengue fever or are in an area where the disease is prevalent, seek medical attention promptly.


There is no specific antiviral treatment for dengue fever. Management primarily involves relieving the symptoms and providing supportive care, such as staying hydrated and taking pain relievers like acetaminophen. Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided because they can increase the risk of bleeding.

The medical and nursing management of dengue fever involves a combination of supportive care and monitoring to alleviate symptoms, prevent complications, and promote recovery. Here’s a comprehensive overview of the medical and nursing management of dengue fever:

Medical Management:

Diagnosis: Accurate diagnosis through clinical evaluation and laboratory tests (serology or PCR) is essential to confirm dengue fever.

Hospitalization: Depending on the severity of the illness, some patients may require hospitalization. Hospitalization is especially crucial for patients with severe dengue or those at risk of complications.

Fluid Replacement: Adequate hydration is a cornerstone of dengue management. Intravenous (IV) fluids are often administered to maintain fluid and electrolyte balance. Nurses closely monitor patients’ fluid intake and output.

Pain and Fever Management: Analgesics such as acetaminophen are given to relieve pain and reduce fever. Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin should be avoided, as they can increase the risk of bleeding.

Monitoring: Regular monitoring of vital signs, hematocrit levels, platelet counts, and other relevant parameters is crucial to assess the progression of the disease and the patient’s response to treatment.

Blood Transfusion: In severe cases of dengue with hemorrhagic manifestations, blood transfusion may be necessary to replace lost blood components.

Nursing Management:

Assessment: Nurses conduct a thorough assessment of the patient’s clinical status, including vital signs, hydration level, skin condition, and the presence of bleeding or shock symptoms.

Fluid Administration: Nurses administer IV fluids as prescribed by the physician, ensuring that the rate and type of fluid are appropriate for the patient’s condition.

Monitoring: Frequent monitoring of vital signs, especially blood pressure, pulse rate, and respiratory rate, is essential to detect any deterioration in the patient’s condition promptly.

Pain and Fever Control: Nurses administer pain relievers and antipyretics as ordered by the physician and monitor the patient’s response to these medications.

Emotional Support: Providing emotional support and reassurance to the patient and their family is essential, as dengue fever can be a distressing experience.

Education: Nurses educate patients and their families about the importance of hydration, medication compliance, and the signs and symptoms that require immediate medical attention.

Infection Control: Nurses ensure strict infection control measures to prevent the spread of the virus, particularly in healthcare settings. This includes proper hand hygiene and personal protective equipment (PPE) use.

Patient Education: Patients should be educated about the prevention of mosquito bites and the importance of seeking prompt medical care if their condition worsens.

Discharge Planning: When the patient is stable and ready for discharge, nurses provide instructions for continued care at home, including medication schedules and follow-up appointments.

The medical and nursing management of dengue fever should be tailored to the individual patient’s condition and may vary based on the severity of the illness. Close collaboration between healthcare providers, including physicians, nurses, and other healthcare staff, is crucial to ensure optimal patient care and recovery.

Health Advantages of Sex

Sex is a vital part of your life.

Sex and sexuality are natural parts of existence. Aside from reproduction, sex may be about closeness and pleasure. Sexual activity, also known as penile-vaginal intercourse (PVI) or masturbation, can provide numerous unexpected advantages to many aspects of your life:

  • physical
  • intellectual
  • emotional
  • psychological
  • social

Sexual health is more than just preventing illnesses and unexpected pregnancies. According to the American Sexual Health Association, it is also about accepting that sex may be an essential part of your life.

How does sex help your body?

This study reveals that sex can be beneficial to cardiovascular health in young men and women. Though sex isn’t sufficient exercise in and of itself, it can be called mild exercise.

Sex may provide you with a variety of advantages, including:

  • blood pressure lowering
  • calorie consumption
  • improving heart health and muscular strength lowering your chances of heart disease, stroke, and hypertension
  • enhancing libido

People who are sexually active tend to exercise more regularly and eat healthier than those who are less sexually active. Physical fitness may also increase overall sexual performance.

9 strategies to boost your sexual performance:

Healthy immune system

Persons who had regular intercourse (one to two times per week) had higher immunoglobulin A (IgA) in their saliva, according to a research of immunity in people in romantic relationships. People who had sex seldom (less than once a week) had considerably lower IgA levels.

IgA is an antibody that plays a role in disease prevention and is the first line of defence against human papillomavirus, or HPV.

Those who had sex more than three times per week, on the other hand, had the same amount of IgA as those who had infrequent sex. According to the study, worry and stress may wipe out the favourable impacts of sex.

better sleep

During an orgasm, your body produces oxytocin, generally known as the “love” or “intimacy” hormone, as well as endorphins. Sedation can result from the combination of these hormones.

Better sleep can help with:

  • a more powerful immune system
  • a higher life expectancy,
  • feeling more relaxed, and
  • having more energy during the day

Relief from headaches

According to another study, sexual activity can offer complete or partial relief from migraines and cluster headaches.

Among those who were sexually active at the time of their attacks:

  • During a migraine, 60% experienced an improvement.
  • During a migraine, 70% experienced moderate to total relief.
  • 37 percent reported relief in cluster headache symptoms.
  • 90% received moderate to total relief from cluster headaches.

How sex helps both males and females?

In males

According to a recent study, males who had more frequent penile-vaginal intercourse (PVI) had a lower chance of acquiring prostate cancer.

According to one study, males who had 4.6 to 7 ejaculations each week were 36% less likely to be diagnosed with prostate cancer before the age of 70. In contrast, men reported ejaculating 2.3 or less times each week on average.

Sex may potentially alter men’s mortality. One 10-year research found that males who had frequent orgasms (defined as two or more per week) had a 50% lower mortality risk than those who had sex less often.

Although the evidence is mixed, more sexual activity may improve the quality and health of your sperm, according to some studies.

In Females:

An orgasm stimulates blood flow and produces natural pain-relieving substances.

Sexual activity in women can:

  • enhance bladder control
  • ease menstruation and premenstrual cramps
  • boost fertility
  • create stronger pelvic muscles
  • assist generate more vaginal lubrication
  • may protect you against endometriosis, or the growth of tissue outside the uterus

Sex can help strengthen your pelvic floor. A stronger pelvic floor can also provide benefits such as decreased discomfort during sex and a lower risk of vaginal prolapse. According to one source, PVI can result in reflexive vaginal contractions triggered by penile thrusting.

Women who remain sexually active after menopause are less likely to get substantial vaginal atrophy, or weakening of the vaginal walls. Pain during sex and urinary symptoms might be caused by vaginal atrophy.

How does sex help your mental health?

Sexual activity, whether with a partner or masturbation, can have significant psychological and emotional advantages. Sex, like exercise, can help relieve stress and anxiety while increasing enjoyment.

According to research, sexual activity (classified as PVI) may be related to:

  • higher pleasure with your mental health
  • enhanced trust, closeness, and love in your relationships
  • better capacity to sense, recognise, and express emotions
  • reduced utilisation of your immature psychological defence system, or mental processes to decrease emotional conflict suffering`

Sexual activity may have an impact on your well-being and capacity to think as you become older. According to research, sexually active persons aged 50 to 90 had stronger memory. They were also less prone to experience depression and loneliness.

Booster of self-esteem

Sexual activity on a regular basis, whether with a partner or alone, might make you seem younger. This is attributed, in part, to the production of oestrogen during intercourse.

One study discovered a link between regular sexual activity and seeming much younger (between seven to 12 years younger). The majority of these people were likewise at ease with expressing their sexuality and sexual identity.

Social advantages

Because of oxytocin, sex can help you bond with your spouse. Oxytocin can help people form connections. You may discover that frequent, reciprocal sexual enjoyment aids in interpersonal connection.

When couples meet one other’s sexual urges, they generally report higher levels of relationship satisfaction. When you are able to communicate yourself and your sexual wants, you may notice great progress in your relationship.

What are the advantages to masturbation?

Masturbation can provide many of the same benefits as sex, but it also has its own set of benefits, which include:

  • improved sex between partners
  • better awareness of your own body
  • higher orgasmic capacity
  • improved self-esteem and body image
  • more sexual pleasure
  • therapy for sexual problems

Masturbation is regarded completely harmless and has little health hazards. There is no danger of pregnancy or sexually transmitted illnesses when done alone (STIs). According to Planned Parenthood, it improves mental health rather than mental disease or instability, as some misconceptions indicate.

Abstinence and celibacy

Sex isn’t the only factor that influences one’s health or happiness. You may live an active and happy life without having sex. The advantages of sex stem from the sensation of pleasure, which studies have shown may also be obtained by listening to music, interacting with pets, and having a strong religious beliefs. According to the National Health Service in the United Kingdom, a long-term study of nuns found that many of them lived into their 90s and beyond.


Sex is an essential component of existence and total well-being. Orgasms play an important role in romantic bonding. Sex can provide physical and mental advantages such as lower risk of heart disease, increased self-esteem, and more.

You can have identical results without intercourse. Other enjoyable activities, such as exercising, engaging with a pet, and maintaining a strong social network, may provide similar advantages. Sex is only one strategy to improve your overall quality of life.

However, whether sex is a part of your life because of a relationship or desire, it is critical that you be able to communicate and enjoy sexual fulfilment. When you make time for sex, you may discover relaxation and an increase in happiness.


Sex during periods/Menstruation

Is It Safe to Have Sex During Your Period?

  • Benefits
  • Side Effects
  • Tips,

 Can you have sex during your period?

You will have a menstrual cycle once a month during your reproductive years. There’s no need to avoid sexual activity during your period unless you’re very sensitive. Though period sex might be messy, it is completely safe. Having sex while menstruation can also provide certain benefits, such as relief from menstrual cramps.



There are a few advantages to having sex during your period:

  1. Pain relief from cramping

Menstrual cramps may be relieved by orgasms. Menstrual cramps are caused by your uterus contracting in order to discharge its lining. When you have an orgasm, the muscles in your uterus contract as well. Then they let go. Period cramps should be relieved by this release.

Sex also causes the production of endorphins, which are hormones that make you feel wonderful. Furthermore, sexual activity diverts your attention away from your period discomfort.

  1. Short duration of periods

Sex may cause your periods to be shorter. Muscle spasms during an orgasm force the uterine contents out more quickly. This might lead to shorter durations.

  1. increased sexual desire

Because of hormonal shifts, your libido alters during your menstrual cycle. While many women indicate that their sex desire increases about two weeks before their period, others report feeling more turned on during their period.

  1. Natural lubricant

During your period, you can store the KY. The blood serves as a natural lubricant.

  1. It could help with your headache.

Approximately half of women with migraine headaches have them during their periods. Although most women with menstrual migraines avoid sex during their attacks, many of those who do report that it improves their headaches partially or entirely.

 What are the possible side effects?

The most obvious disadvantage of having sex during your period is the mess. When you have a high flow, blood might go on you, your partner, and the bedding. Aside from making your bed messy, bleeding might make you feel self-conscious. Anxiety over making a mess might detract from the enjoyment of sex.

Another concern about having sex during your period is the possibility of contracting a sexually transmitted infection (STI) such as HIV or hepatitis. These viruses dwell in blood and can be transmitted by contact with contaminated menstrual blood. Using condoms whenever you have sex reduces your chances of transmitting or contracting a STI.

If you intend to have sex while on your period and are wearing a tampon, you must remove it beforehand. During intercourse, a forgotten tampon can be pushed so far up into your vagina that you’ll need to visit a doctor to have it removed.


Can you get pregnant/conceive?

If you aren’t actively attempting to conceive, utilizing protection is a smart idea regardless of where you are in your menstrual cycle. Your chances of becoming pregnant are decreased during your period, but it is still possible.

You are most likely to become pregnant during ovulation, which occurs around 14 days before your period begins. However, each woman’s cycle duration is unique, and your cycle length might alter monthly. If you have a short menstrual cycle, you are more likely to become pregnant during your period.

Consider the fact that sperm may dwell in your body for up to seven days. So, if you have a 22-day cycle and ovulate soon after having your period, you may be releasing an egg while sperm are still in your reproductive tract.


Is it necessary to wear/use protection?

Using protection will also protect you against STIs. Because viruses like HIV thrive in menstrual blood, you can not only get a STI during your period, but you can also more readily transmit one to your partner.

Wear a latex condom every time you have sex to lower your chances of becoming pregnant and contracting a STI. If you or your spouse are allergic to latex, there are other options for protection. You can get advice from your pharmacist or doctor.


Tips on having sex during your period

Here are a few pointers to make period sex more pleasant and less messy:

Communicate openly and honestly with your spouse. Tell them how you feel about having sex during your period and inquire about their feelings. If either of you is apprehensive, discuss the reasons for your unease.

If you’re wearing a tampon, take it out before you start messing about.

To collect any blood drips, place a dark-colored cloth on the bed. Or, to avoid the mess totally, have sex in the shower or bath.

Keep a damp towel or wet wipes beside the bed for cleanup.

Wear a latex condom with your lover. It will provide protection against pregnancy and STIs.

If your typical sexual position makes you uncomfortable, try something new. Try resting on your side with your spouse behind you, for example.


Don’t let your period prevent you from having fun. If you do a little planning, sex may be just as delightful on those five or so days as it is the rest of the month. You might be startled to discover that sex is much more stimulating during your period.

Multiple Sclerosis

Multiple sclerosis (MS) is a chronic demyelinating disease that affects the myelin sheath of neurons in the CNS. Multiple-Sclerosis-Infographic Multiple sclerosis is a disease that causes vision problems, numbness and tingling, muscle weakness, and other problems. It happens when the body’s infection-fighting system attacks and damages nerve cells and their connections in the brain and spinal cord. When the body’s infection-fighting system, called the “immune system,” attacks the body’s own cells, it is called an “autoimmune response.” It causes damage to myelin, the protective coating around the nerves. When myelin is damaged, messages can no longer be clearly transmitted from the brain and spinal cord to other parts of the body. Many people refer to multiple sclerosis as “MS.” INCIDENCE

  • Onset occurs between 20-40 years of age.
  • Women are more affected than men. (AANN, 2011).
  • Whites are more affected than Hispanics, blacks, or Asians.
  • Most prevalent in colder climates of North America & Europe.
  • Migration.



  • Exact cause is not known yet.
  • Most theories suggest that MS is an immunogenetic viral disease (with Epstein Barr virus).

Risk factors are:

  • Age (most of the time between 20-40 yrs).
  • Sex (women have more chance).
  • Family history (genetic susceptibility).
  • Certain infections (like Epsteinbarr virus).
  • Climate (more in cold climate areas).
  • Certain auto-immune diseases (higher risks with thyroid disease, type-1 DM or IBD).
  • Smoking.
  • Stress, fatigue.
  • Physical injury.
  • Pregnancy (may relating to stress to labour, or puerperium).


PATHOPHYSIOLOGY Due to etiological factors Activated T-cells (which recognise self Ag) expressed in CNS, & Macrophages (B-cells) enters the brain from peripherral circulation Production of inflammatory cytokines & reactive O2 species Inflammation Then activated T-cells & B-cells cause demyelination and destruction of oligodendrocytes Formation of plaque Causes scarring & destruction of sheath Compensatory system starts causing subsidation of edema & inflammation After that some remyelination process occurs which is often incomplete Multiple sclerosis. CLINICAL MANIFESTATIONS The course of illness varies from person to person.

  1. Fatigue is the lack of physical and mental energy that impacts daily tasks. Fatigue can be physical or mental and is not correlated to how much rest or sleep a person gets. It is one of the most common symptoms and impacts about 80 percent of people living with MS. It can be http://nursingfile.com/wp-content/uploads/2013/12/multiple-sclerosis-249x300.jpg the most debilitating factor, even for those who have minimal physical restrictions, and is one of the leading causes for people leaving the workforce.
  2. Heat intolerance in MS is a temporary worsening of symptoms with elevated body temperatures including hot and humid weather, exercising, sunbathing, or fevers. A small rise in body temperature (a quarter to a half a degree) can cause increased fatigue, tingling, blurry vision, or even the inability to walk. Most people living with MS have to avoid outdoor activity and/or use cooling garments to complete simple, daily activities due to this intolerance.
  3. Cognitive dysfunction affects high-level brain functions such as memory, attention/concentration, the ability to solve daily problems, understand and use language, and process information from different senses. Impaired cognition affects 50-65 percent of those living with MS and is another major reason for leaving the workforce early.
  4. Pain/abnormal sensation is a common symptom with MS and can be directly related to neuropathic pain (the disease process itself) or from musculoskeletal pain (changes to the body and immobility). The pain experience is unique to each person and can greatly limit his or her ability to participate in and enjoy socialization and activities. Those living with MS can also experience various abnormal sensations such as numbness and tingling, prickling, sharp/stabbing pains, hot/cold sensations, and burning pains which can also impact movement and daily function.
  5. Depression comes in various forms and can be one of the most common symptoms in MS, more common in people with MS than the general population. Depression can happen to anyone at any time during the disease course and does not correlate to disease severity, however it can greatly impact someone’s quality of life and ability to participate in daily activities.


COMPLICATIONS People with multiple sclerosis may also develop:

  • Muscle stiffness or spasms
  • Paralysis, typically in the legs
  • Problems with bladder, bowel or sexual function
  • Mental changes, such as forgetfulness or mood swings
  • Depression
  • Epilepsy


  • There is no definitive test for MS.
  • Detailed history of episodes of neurologic dysfunction
  • Physical examination.

Other tests include:-

  • CSF evaluation (for presence of IgG antibody or oligoclonal bonding)
  • Evoked potentials of optic pathways & auditory system to assess presence of slowed nerve conduction.
  • MRI of brain and spinal cord (to determine the presence of MS plaques)
  • CT scan (to detect areas of demyelination, but with less detail as by MRI).



• No exact cure.
• Aim is to prevent or postpone the long term disability (often evolves slowly over many years).
• The treatment falls into 3 categories:-
1. Treatment of acute relapses.
2. Treatment aimed at disease management.
3. Symptomatic treatment.

1. Treatment of acute relapse:-

  • Corticosteroid therapy ( anti-inflammatory & immunosuppressive property )
  • For example:
  • Methyl-prednisolone , (given I.V. or orally)
  • Azathioprine & cyclophosphamide (in severe cases)

2. Treat exacerbations:- (treatment aimed at disease management)

  • Interferon-Beta 1b
    • Betaseron, given subcutaneously. (antiviral & immuno-regulatory) (For ambulatory clients with relapsing –remitting).
  • Interferon Beta 1a
    • Avonex, (for treating replasing form of MS).
  • Glatiramer acetate
    • Copaxane, (for relapsing re-emitting MS).

3. Symptomatic treatment:-

  • For bladder dysfunction:
    • oxybutynin, propantheline.
  • For constipation:
    • psyllium hydrophilic mucilloid, suppositories.
  • For fatigue:
    • amantadine, modafinil .
  • For spasticity:
    • baclofen, diazefen, dantrolone.
  • For Tremor :
    • propanolol, phenobarbital, clonazepam.
  • For dysesthesias & trigeminal neurolgia:
    • carbamazepine, phenytoin, amitriptyline.
  • For dysesthesias:
    • Transcutaneous electrical nerve stimulation (TENS) is also helpful.

4. Nutritional therapy:-

  • Megavitamin therapy (cobalamin/vit. B12 and vit. C)
  • Low fat diet.
  • high roughage diet (to relieve constipation)

5. Other therapies:- (to improve neurological functioning)

  • Physical and speech therapies.
  • Exercise.
  • Water exercise.



  • Deep brain stimulation:-
    • if other options have failed then a device is implanted that stimulates an area of brain. (in case of severe tremor in limbs).
  • Implantation of a drug catheter or pump:
    • a catheter is placed in lower spinal area to deliver a constant flow of drug like baclofen. (in case of severe pain or spasticity).


    • Impaired physical mobility related to fatigue & weakness
    • Activity intolerance r/t weakness, dizziness, and unsteady gait
    • Self-esteem disturbance r/t loss of health & lifestyle changes



    1. Promotes physical mobility – activity and rest
  • no vigorous physical exercise
  • frequent rest periods
  • walking and gait exercises
  • minimize spasticity and contractures – warm packs, daily muscle stretching
  • activities: swimming, stationary bike, progressive wt bearing
  • Minimize effects of immobility; skin integrity; cough and deep breathing exercises.
    1. Prevent injury – walk with feet wide apart, environment awareness and modification, gait training. Use of assistive devices – walker, cane etc.
    2. Promote bladder & bowel control – Urinal/bedpan readily available, po fluids intake schedule/voiding schedule, increase fiber in diet, intermittent self-catheterization
    3. Improve sensory and cognitive function:
  • Vision – eye patch for diplopia; prism glasses for reading; talking books
  • Speech – slurred, low volume, problems with phonation – speech therapist
  • Cognitive & emotional responses – forgetfulness, easily distracted, emotionally labile, social activities; hobbies.
    1. Development of coping strengths – education about diseases process; stress relief; network of services – social, speech, PT, psychological, homemaker/meal on wheels
    2. Improve self-care – assistive devices, raised toilet seat, shower bench, reached tongs, decrease physical and emotional stress, decrease exposure of extreme temperatures
    3. Adapting to sexual dysfunction – counseling, plan sexual activity, willingness to experiment.

Answer Key: Pre-Interview Written test for the post of Staff Nurse (BPS-16)- SPSC-2019

Sindh public service commission (SPSC)
Pre-Interview Written test for the post of Staff Nurse (BPS-16)
Question Paper: 24th August,2019

Answer key
1. C
2. B
3. B
4. A
5. C
6. C
7. A
8. C
9. A
10. A

11. C
12. B
13. B
14. D
15. C
16. B
17. A
18. C
19. D
20. B

21. A
22. D
23. A
24. C
25. D
26. B
27. B
28. B
29. C
30. C

31. C
32. D
33. B
34. B
35. A
36. B
37. C
38. B
39. B
40. B

41. B
42. C
43. C
44. D
45. A
46. D
47. D
48. B
49. B
50. A


For QUESTION PAPER, please click on the below link:

Pre-Interview Written test for the post of Staff Nurse (BPS-16)- SPSC-2019


Pre-Interview Written test for the post of Staff Nurse (BPS-16)- SPSC-2019

Sindh public service commission (SPSC)
Pre-Interview Written test for the post of Staff Nurse (BPS-16)
Question Paper: 24th August,2019

1. Synonym of “Absolute”.
(A) Half
(B) Small
(C) Complete
(D) Divide
2. The pacemaker of the heart is termed as:
(A) Atrioventricular node
(B) Sinoatrial node
(C) Left and right bundle branches
(D) Purkinje fibers
3. Which plasmodium cases “malignant malaria”?
(A) P. Vivax
(B) P. Falciparum
(C) P. Ovale
(D) P. Malaria
4. Inflammation of the tongue is termed as:
(A) Glossitis
(B) Gingivitis
(C) Stomatitis
(D) Parotitis
5. Choose the correct option: Ahmed is more responsible________ any _______________boy in his class.
(A) Then, some
(B) Then, some
(C) Than, other
(D) None of these
6. A healthy person can donate blood in a:
(A) Six or seven
(B) Five or six
(C) Three or four
(D) Two of three
7. Where does fertilization of an ovum by sperm usually take place?
(A) In the fallopian tube
(B) In the vagina
(C) In the uterus
(D) In the ovary
8. The world’s tallest mountain peak is in:
(A) China
(B) Pakistan
(C) Nepal
(D) India
9. Hypokalemia is the condition if serum __________ level is less than normal
(A) Potassium
(B) Sodium
(C) Calcium
(D) Chlorine
10. Which of the following colored container must be used for discarding human anatomical waste in hospital?
(A) Yellow
(B) Red
(C) Blue
(D) Black

11. From among the underlined words below find the error, if any: Had (A) he been (B) there, he would(C) grappled (D) with the situation.
12. When helping a client who is recovering from a stroke to walk, the nurse should assist:
(A) On the client’s strong side
(B) On the client’s weak side
(C) From behind the client
(D) With the wheelchair
13. The Suez Canal is in:
(A) Panama
(B) Egypt
(C) Sweden
(D) Switzerland
14. Which temperature is considered most accurate?
(A) Oral
(B) Axillary
(C) Groin
(D) Rectal
15. Hygiene is a word derived from?
(A) Latin
(B) English
(C) Greek
(D) French

16. One teaspoon contains:
(A) 2 ml
(B) 5 ml
(C) 10 ml
(D) 15 ml
17. The nerve, which carries messages from the brain and spinal cord to muscles and glands is:
(A) Motor nerve
(B) Sensory nerve
(C) Mixed nerve
(D) Autonomic nerve
18. Which type of precautions should be nurse implement for the client diagnosed with septic meningitis?
(A) Standard precaution
(B) Airborne precaution
(C) Contact precaution
(D) Droplet precaution
19. Most important aspect of hand washing is:
(A) Time
(B) Type of soap
(C) Surface tension
(D) Friction
20. Which of the following diseases is inheritable?
(A) Leukaemia
(B) Colour blindness
(C) Malignancy
(D) Hepatitis
21. Precautions used when caring for a rubella patient is:
(A) Droplet
(B) Contact
(C) Universal
(D) Hand washing
22. It is appropriate for a nurse to share the information regarding a client’s status with:
(A) Any one the nurse sees fit
(B) The client’s family members
(C) The client’s roommate
(D) The staff on the next shift
23. A method of making the victim to breath passively is:
(A) Artificial respiration
(B) Spontaneous respiration
(C) Deep breathing
(D) Kusmal breathing
24. Deficiency of __________________ in blood causes simple goiter.
(A) Sodium
(B) Iron
(C) Iodine
(D) Calcium
25. The nurse is preparing to take vital sign in an alert client admitted to the hospital with dehydration secondary to vomiting and diarrhea. What is the best method used to assess the client’s temperature?
(A) Oral
(B) Axillary
(C) Rectal
(D) Heat sensitive tape

26. The photoreceptors in eye are present in the:
(A) Iris
(B) Retina
(C) Sclera
(D) Cornea
27. Tendon connects:
(A) Cartilage with muscles
(B) Bone with muscles
(C) Ligament with muscles
(D) Bone with bone
28. The prescription orders are 0.125 mg digoxin orally. Tablets containing 0.25 mg is available. How many tablets will you administer?
(A) 1 tablet
(B) 1/2 Tablet
(C) 2 Tablets
(D) ¼ tablet
29. Which of the following is intravascular fluid?
(A) Lymph
(B) Pleural fluid
(C) Plasma
(D) Synovial fluid
30. The highest concentration of HIV virus is found in?
(A) Saliva
(C) Blood
(D) Semen
31. Antonym of “Barren”:
(A) Radiant
(B) Besiege
(C) Fertile
(D) Full
32. To best communicate with a client who is totally deaf, the nurse should:
(A) Smile frequently and speak loudly
(B) Smile often and talk rapidly
(C) Avoid eye contact
(D) Write out information
33. The capital of Canada is:
(A) Toronto
(B) Ottawa
(C) Ontario
(D) Montreal
34. Information given by the sufferer about his illness is termed as:
(A) Sign
(B) Symptoms
(C) Observation
(D) Diagnosis
35. Which of the following has lowest pH?
(A) Gastric juice
(B) Hepatic bile
(C) Pancreatic juice
(D) Diagnosis

36. When a client has left-sided weakness, what part of a sweater is put on first?
(A) Both sleeves
(B) Left sleeves
(C) Client’s choice
(D) Right sleeve
37. Choose the correct option: “Zulfiqar _____________ this house last year”.
(A) Sells
(B) Sell
(C) Sold
(D) Is selling
38. Best method of disinfection of hospital waste is:
(A) Fumigation
(B) Incineration
(C) Sunlight
(D) Burying
39. The last sense a dying client will lose is:
(A) Smell
(B) Hearing
(C) Taste
(D) Sight
40. A thousand ml. of Normal Saline is to be infused in 8 hours. What should be the rate of flow pert minute?
(A) 20 drops
(B) 30 drops
(C) 40 drops
(D) 50 drops
41. Route of transmission of Hepatitis B is:
(A) Oral
(B) Potential
(C) Faeco oral
(D) Contaminated water
42. Where is erythropoietin hormone synthesized?
(A) Spleen
(B) Liver
(C) Kidney
(D) Thyroid
43. A client needs to be repositioned but is heavy and the nurse is not sure she can move the client alone. The nurse should:
(A) Try to move the client alone
(B) Have the family do it
(C) Ask another nurse to help
(D) Go on to another task
44. Where is the tomb of Mughal Emperor Jahangir?
(A) Multan
(B) Karachi
(C) Peshawar
(D) Lahore
45. Mode of transmission of Hepatitis E is?
(A) Water borne
(B) Blood borne
(C) Air borne
(D) Trans placental

46. The international court of Justice is located in:
(A) New York
(B) London
(C) Geneva
(D) The Hague
47. BCG (Bacillus Calmatte Guerine) vaccination is injected to get immunity from:
(A) Polio
(B) Cholera
(C) Small pox
(D) Tuberculosis
48. Cortisone is ___________.
(A) Protein
(B) Steroid
(C) Carbohydrate
(D) Nucleic acid
49. Hearing receptor cells are located in ______________.
(A) Ossecles
(B) Organ of corti
(C) Oval windows
(D) Eardrum
50. Which of the following is a first-line drug used for pain management?
(A) Acetaminophen
(B) Clonidine
(C) Morphine
(D) Ketamine


For ANSWER KEY, please click on the below link:

Answer Key: Pre-Interview Written test for the post of Staff Nurse (BPS-16)- SPSC-2019

Is it Possible to Get Pregnant Without Having Sex? You Might Be Surprised by the Answer

Women are claiming that this has happened to them; are they telling the truth?

Everyone who has taken a basic sex education class is aware that having unprotected sex carries the risk of becoming pregnant. As a result, it’s difficult to believe that a woman can become pregnant without having penetrative sex. It turns out that it isn’t, and some people online claim that it happened to them.

Sammi Isabel’s story was told in a TikTok video, which quickly went viral. Isabel stated in the video that she became crampy at her prom and discovered her period was a week late. Despite the fact that she was a virgin at the time, she took a pregnancy test—and it came back positive. “And that’s how I have a 5-year-old son,” she captioned the photo.

Isabel insisted in a later TikTok that she wasn’t making up her story. “I just want people to know it’s a possibility,” she explained.

Isabel is far from the first woman to claim something similar happened to her. Wathoni Anyassi revealed on her YouTube channel LoloTalks that she became pregnant as a virgin as well. “I thought, ‘Wow, pregnant.'” ‘How did this happen?’ she recalls thinking in her video.

It’s easy to dismiss these stories as hoaxes. Ob-gyns, on the other hand, swear that these so-called virgin pregnancies do exist.

More women than you might think have gotten pregnant without having sex.

According to a data analysis published in the BMJ in 2013, 45 of the 7,870 women who participated in the National Longitudinal Study of Adolescent Health said they had a virgin pregnancy that wasn’t related to reproductive assistance, such as IVF or intrauterine insemination (IUI). The researchers discovered that these reports were more common among women who signed chastity pledges or whose parents didn’t talk to them about sex and birth control much, if at all.

A major caveat, according to the researchers: getting pregnant without having sex is usually difficult to prove. “Even with numerous enhancements and safeguards to optimise reporting accuracy,” they wrote, “researchers may still face challenges in the collection and analysis of self-reported data on potentially sensitive topics.”

However, Lauren Streicher, MD, a clinical obstetrics and gynaecology professor at Northwestern University’s Feinberg School of Medicine, tells Health that many clinicians have observed this. “Many obstetricians have experiences about delivering someone who claims to be a virgin with an unbroken hymen,” she explains. “There are unquestionably virgin births.”

The use of an intact hymen—a small amount of additional tissue around the vaginal opening—to prove virginity is controversial, because the hymen can rip or stretch over time as a result of wearing tampons, having gynaecological exams, and engaging in strenuous activity. Dr. Streicher believes that if a lady has an intact hymen and claims she’s never had penetrative sex, her virgin pregnancy narrative is more likely.

Other ob-gyns agree that this is a thing. “Indeed, this is feasible,” says Mary Jane Minkin, MD, a clinical professor of obstetrics and gynaecology and reproductive sciences at Yale Medical School.

“The danger of getting pregnant in this method is very low because sperm can only live for a brief time outside of the body,” women’s health expert Jessica Shepherd, M.D., an ob-gyn in Dallas, Texas, tells Health. “However, it is still feasible and has happened in women.”

Okay, but how can you get pregnant if you don’t have sex?

There must be sperm and an egg, among other things, for a pregnancy to develop. Those two are normally associated with penetrative intercourse, but Dr. Shepherd points out that they can also be associated with messing around.

“This can happen when sperm get into the vagina—for example, if the male ejaculates at the vaginal opening, or if a partner’s erect penis comes into contact with the body near the vagina,” she explains. Dr. Minkin believes the initial few drops of seminal fluid (the fluid that carries sperm out of a man’s penis) “have lots of sperm,” adding, “they simply need to make their way up into the vagina and up to the cervix.”

According to Dr. Minkin, virgin pregnancies are more likely to occur in younger people who are more fertile. “Women need to know that this is clearly a genuine issue and that pregnancies may occur without penetration,” Dr. Streicher adds. All you need is sperm at the vaginal opening—they’re terrific swimmers.”

So, what can people do to avoid a virgin pregnancy?

FWIW, this is an uncommon occurrence, so don’t lie awake at night wondering that you’re pregnant if you didn’t go all the way. Having said that, there is enough of a danger of becoming pregnant without having intercourse that you should probably take measures in the future.

If your partner’s penis or semen comes into touch with or goes close to your vagina, even if it doesn’t go inside, “use the same contraception that you would use if you were having penetrative intercourse,” Dr. Streicher says. “It’s really no different.”

Barrier birth-control techniques (such as condoms containing spermicide) can be beneficial, according to Dr. Shepherd. Plan B is also a possibility if you’re not sure how safe you were when you were fooling about, according to her. Dr. Minkin adds that long-acting reversible contraception, such as an IUD or a birth control implant, can assist give protection when you don’t want to worry about birth control.

Again, this isn’t very frequent, and many women have cheated on their boyfriends without becoming pregnant. Even so, it’s crucial to be aware that there is a danger.